Umbilical cord prolapse is a rare but serious complication that can occur during childbirth. It happens when the umbilical cord descends before the baby, restricting the baby’s oxygen supply. This makes it a time-sensitive medical emergency. This article provides information on what it entails, its frequency, risk factors, and immediate medical responses.
What is Cord Prolapse?
Umbilical cord prolapse occurs when the umbilical cord slips through the cervix, the opening of the uterus, ahead of the baby’s presenting part. This event usually occurs during labor or just before delivery, often after the amniotic sac (water) has broken. The cord can then be compressed between the baby’s body and the mother’s pelvis or cervix, severely limiting or cutting off blood flow and oxygen to the baby. The reduced oxygen supply resulting from cord compression can lead to fetal distress. There are two primary forms: overt, where the cord is visible or can be felt in the vagina, and occult, where it lies alongside the baby’s presenting part without being immediately visible.
How Often Does it Occur?
Umbilical cord prolapse is a rare occurrence in pregnancies. Its incidence is estimated to be approximately 1 in every 300 to 1 in 1000 births. Some studies report a slightly broader range, indicating it affects between 0.1% and 0.6% of all deliveries. While it can occur in any pregnancy, it is observed more frequently in multiple gestations, particularly for the second twin. Most cases happen shortly after the rupture of the amniotic membranes.
Recognizing Risk Factors
Several circumstances can increase the likelihood of umbilical cord prolapse. An abnormal fetal position, such as breech (feet or buttocks first) or transverse (lying sideways), is a significant risk factor. When the baby’s presenting part does not fit snugly into the pelvis, it creates an open space through which the umbilical cord can slip. An excessive amount of amniotic fluid, known as polyhydramnios, also contributes to the risk, as this increased fluid volume provides more room for the cord to move.
Babies born prematurely or with a low birth weight are at higher risk, partly because their smaller size may not effectively block the cervical opening. Multiple pregnancies, such as carrying twins or triplets, further elevate the risk. Certain medical procedures performed during labor, including the artificial rupture of membranes when the baby’s head is not well-engaged, or the insertion of internal monitors, can also unintentionally create conditions for the cord to prolapse.
Emergency Response and Management
Umbilical cord prolapse is a medical emergency demanding immediate action to safeguard the baby’s well-being. The primary objective of medical intervention is to relieve any pressure on the umbilical cord and restore the flow of oxygen-rich blood to the baby. Healthcare providers may manually lift the baby’s presenting part away from the cord to alleviate compression. Repositioning the mother can also be effective; assuming a knee-to-chest or Trendelenburg (head-down) position uses gravity to shift the baby and reduce cord compression. In some situations, filling the mother’s bladder with sterile saline can temporarily elevate the baby’s head, creating more space around the cord.
Once cord prolapse is diagnosed, the baby typically needs to be delivered quickly, most often through an emergency Cesarean section. While a vaginal delivery might be considered if birth is extremely close, a Cesarean section is usually the safest and fastest method to prevent prolonged oxygen deprivation.
Most babies survive umbilical cord prolapse, particularly when managed promptly in a hospital setting. However, if the oxygen supply is compromised for an extended period, the baby may experience complications such as brain injury or other neurological issues. The risk of severe outcomes, including infant death, is considerably higher if the prolapse occurs outside of a medical facility.